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7605 Edinborough Way Apt 6214 Edina MN 55435-5827 | |
| (651) 434-2166 | |
| (651) 927-0233 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 7605 Edinborough Way Apt 6214, Edina, Minnesota |
| Authorized Official Name and Position | Samuel Lais Major (OWNER) |
| Authorized Official Contact | 6514342166 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
7605 Edinborough Way Apt 6214 Edina MN 55435-5827 Ph: (651) 434-2166 | 7605 Edinborough Way Apt 6214 Edina MN 55435-5827 Ph: (651) 434-2166 |
| NPI Number | 1265992994 |
|---|---|
| Provider Enumeration Date | 03/20/2019 |
| Last Update Date | 10/14/2022 |
| Certification Date | 10/14/2022 |
| Medicare PECOS PAC ID | 2163967803 |
|---|---|
| Medicare Enrollment ID | O20240717002703 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265992994 | NPI | - | NPPES |
| Provider Name | Samuel Major |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1114461209 PECOS PAC ID: 6800240680 Enrollment ID: I20240717002830 |
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